What's to know about breast cancer dimpling
Cancer is not the only reason why dimpling occurs in the breast tissue, but if the breast also feels red and warm, it may be a sign of cancer that needs urgent treatment.
Being aware of how the breasts' usual appearance can help an individual to notice any symptoms if they occur, for example, changes in texture and color.
What is dimpling?
Anyone who notices dimpling of skin or thickening of tissue in the breast or near the underarm should seek medical help.
Dimpling of the breast tissue can be a sign of a serious form of cancer known as inflammatory breast cancer.
Also known as peau d'orange, dimpling of the breast causes the skin to look like the pitting and uneven skin of an orange. Sometimes, the skin can also be red and inflamed.
The following changes may also occur:
Skin changes: The area around the breast, nipple, or areola may appear red, scaly, or swollen.
Thickening of tissue: This can affect breast tissue or the area near the underarm.
Dimpling as a sign of breast cancer tends to occur in only one breast. If dimpling affects both breasts, the person probably does not have breast cancer. With inflammatory breast cancer, there may not be a lump.
There are two main reasons for breast dimpling. One is fat necrosis, and the other is inflammatory breast cancer.
Inflammatory breast cancer
Unlike other types of breast cancer, inflammatory breast cancer can cause redness and swelling as well as dimpling.
Inflammatory breast cancer is a rare but aggressive type of breast cancer in which cancerous cells affect the lymph vessels and the skin, according to the National Breast Cancer Foundation.
Inflammatory breast cancer accounts for between 1 and 5 percent of all breast cancers, according to the National Cancer Institute. It is more likely to affect younger women.
Breast Cancer.org note that on average, inflammatory breast cancer affects black American women at the age of 52 years and white American women at 57 years. This is around 5 years earlier than most breast cancers.
It often produces no symptoms until stage III or stage IV. Unlike other types of breast cancer, there is no distinct mass or tumor.
Instead, cancer cells block the lymphatic drainage in the breast tissue.
It tends to develop in the milk ducts within the breast.
Early symptoms of inflammatory breast cancer may include itching and a rash or small, irritated bump, similar to a bug bite.
As the symptoms progress, the person may notice:
- pain or a burning sensation
- dimpling of the skin
Nipple changes, such as inversion may also be observed. People may or may not feel a lump in the breast.
Other causes of dimpling
Dimpling can also be a symptom of fat necrosis, a condition where the fatty tissue in the breast dies. It can happen for various reasons, including breast surgery, a bruise or injury, or as a side effect of a biopsy.
There is no link between fat necrosis and breast cancer, but it can also cause a lump and dimpling. Dimpling is more likely if the fat necrosis occurs near the surface of the breast.
The only way to find out if dimpling is due to breast cancer or fat necrosis is by having an examination with a doctor and a breast biopsy.
How to find dimpling
The easiest way to find dimpling is to look at the breasts. While United States Preventive Task Force (USPTF) no longer recommends regular breast self-exams, it is important to know how the breasts normally look and feel.
Looking for dimpling is simple.
The best time to do it is to take a few minutes when getting dressed or changing clothes.
To screen for dimpling:
- Check out the tissue covering the breasts and underarm areas.
- Note any changes in the skin, including lumps or changes in texture.
- Feel the breasts to check for lumps, areas of tenderness, or thickening in the breast or under the arms.
It is best to check regularly and at all stages of the menstrual cycle so that you can know how the breasts change over time.
An individual should see a doctor if they notice dimpling or other changes in the breast tissue.
To find out why the dimpling is there, the doctor:
- will perform a clinical breast exam
- may order further testing, such as a mammogram or ultrasound
- may recommend a biopsy, depending on the results of the imaging tests
In a biopsy, the doctor takes some tissue from the breast to check for cancerous cells.
If a biopsy shows that cancer is present, the doctor may request further tests, for example, a PET or CT scan, to see if the cancer has spread to other places.
According to the National Cancer Institute, doctors use the following criteria to diagnose inflammatory breast cancer:
- redness, swelling, and ridged or pitted skin that appears suddenly.
- warmth in the breast that starts suddenly, either with or without a lump and with or without the redness, swelling, and dimpling.
- these symptoms must have been there for 6 months or less.
- the redness affects at least one third of the breast.
- a biopsy shows that invasive cancer cells are present
An international group of doctors produced these criteria because inflammatory breast cancer is difficult to diagnose.
If dimpling is a sign of breast cancer, it may need urgent treatment.
If the diagnosis shows breast cancer, several treatment options are available.
These depend on the type, stage, and location of the cancer, and whether it has spread.
Treatment options include:
Surgery: A surgeon removes the cancerous tissue or the entire breast.
Chemotherapy: Medications either kill cancer cells or prevent them from growing.
Radiation: High-energy X-rays or radiation targets cancerous tissue and destroys it.
Hormonal therapy: This can block the activity of certain hormones that encourage the growth of cancerous cells. However, the National Cancer Institute points out that this type of cancer often does not respond to hormonal treatment.
Before starting treatment, the doctor will discuss a plan with the individual that offers the best chance for long-term survival and best meets their goals and wishes.
This may mean combining two or more different types of treatment, especially if the cancer is an aggressive type.
It can be worrying to find a lump or other changes in the breasts, but often these changes do not mean that cancer is present.
However, it is important to see a doctor to find the cause, seek treatment if necessary, and — in many cases — to gain peace of mind by ruling out cancer.
Inflammatory breast cancer can be aggressive, and it can progress fast.
As with most cancers, outlook and survival improve with early diagnosis and treatment.